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Fall Protection Plan
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Indicates required field
Site Address:
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Person Completing Form:
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Date:
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Period for Which Plan is Valid:
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Fall Hazard(s) at the Site: Outline the specific situation(s) where fall protection is required, considering what objects are below worker and how far they are below, such as "fences, vehicles, garbage bins 4-6 m below work area.
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Fall Protection System to Be Used at the Site: Details about the type of equipment (harness, lanyard, shock absorber, brands and models of components, length of lanyard, etc.)
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Anchors to be Used: Be specific. Describe the precise anchor point, including anchor strength and location relative to worker.
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Clearance Requirement: This must be calculated. The distance the worker would fall must be less than the distance to the nearest object/surface below.
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Procedures to Assemble, Maintain, Inspect, Use and Disassemble the Fall Protection System: Be detailed. You can attach the manufacturer's specifications for the specific equipment being used and ensure that workers are trained in these procedures.
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Rescue Procedure: The Plan must specify how the worker will be rescued if he/she falls and is suspended. Examples include ladders, aerial devices, self-rescue fall protection equipment (suspension steps that deploy when the shock-absorber deploys, self-rescue SRLs, etc.) Workers must be trained in rescue procedures and conduct practice drills.
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